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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME y /��j <br /> Gv /2 )� ❑ Zoning Status;CUP; <br /> OWNER ADDRE S (Number,St ee C' ,State,Zip) / �j Deed Restriction;CSM <br /> 564, 0��t'(5 iOG� w l 53. Variance(# ) <br /> HOME PHONE CELL PHONE E-CILADDRESS <br /> 3 33y- i( IL yGUY ioe(J <br /> , ) ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL 0? /h['I.Ig3- co- H>, 5/003 frontage drawn to scale. <br /> NUMBER (� VJ / W r�C C <br /> TOWNSHIP/:n/ Y'n/ r� SET N: /'! �j <br /> j(/r)Vi ` 1/4: 't wk. / ❑ Driveway permits <br /> l ` (state,county,town) <br /> ADDRESS: LL, (� 5-0,06w7 > p <br /> S6q4 P66(10 w/ S'75 o g ❑ Sanitary permits <br /> CSM:Cd�7 LOT SI$(ON BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION tf�J <br /> PROJECT DESCRIPTION: k �' ' <br /> Deck <br /> Cl This project is a new building or structure. a- .a <br /> This project is an addition/alteration to an existing building or structure. 1 „ �� <br /> SANITARY SERVICE: PERMIT NU ' , q°' : , <br /> ❑SEWER SEPTIC ': .. 31., a a I m ' '' : -. <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 7 I ' Ar �� <br /> AREA TO NEAREST SQUARE FOOT: k <br /> lr: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) i . `` R <br /> BASEMENT: 1ST FLOOR: ® � r . <br /> TOTAL SQUARE FOOTAGE: 4 �-. @1.4f- s � <br /> 2ND FLOOR: 3RD FLOOR: ® �' <br /> �s% ;om i �, <br /> ESTIMATED CONSTRUCTION COST: <br /> ♦ .4. ♦ -► -► ♦ Y , aa(Please round to nearest dollar) � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ea Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 12d Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes Ea No ❑Don't know <br /> 7. Is this to correct a violation? l.Yes ❑No <br /> )-(0 APPLICATION MUST BE SIGNED <br /> sasllz(aaa) <br /> © (Continue on Back) -► -► <br /> Q <br />